摘要
目的探讨老年化脓性脑膜炎(PM)患者脑脊液病原菌分布、耐药性情况及其对临床用药的指导作用。方法选取2020年5月至2023年5月本院收治的305例老年PM患者,均行脑脊液标本细菌培养及耐药性分析,统计患者脑脊液病原菌分布及耐药情况。根据药敏结果指导临床抗菌药物的使用并分析治疗效果。结果305例老年PM患者脑脊液中共检出病原菌115株,检出率37.70%,其中革兰氏阳性菌72株,占比62.61%,主要为肺炎链球菌、金黄色葡萄球菌和表皮葡萄球菌;革兰氏阴性菌42株,占比36.52%,主要为大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌;真菌1株,占比0.87%;药敏试验结果显示,老年PM患者脑脊液革兰氏阳性菌中所有菌株对氨苄西林、青霉素的耐药率均在80%以上,对苯唑西林的耐药率均在60%以上,对利奈唑胺的耐药率均小于20%,对阿米卡星的耐药率均小于10%,未检出对万古霉素和替考拉宁耐药的菌株,革兰氏阴性菌中所有菌株对氨苄西林、头孢唑林、左氧氟沙星的耐药率均在80%以上,对头孢吡肟的耐药率均在60%以上,对亚胺培南的耐药率均小于20%,对阿米卡星的耐药率均小于10%;根据耐药性分析结果选择耐药率低的抗菌药物对患者进行治疗,患者脑脊液蛋白浓度及白细胞计数均低于用药前,糖浓度高于用药前(P<0.05),总有效率为81.97%(250/305)。结论老年PM患者脑脊液中病原菌以革兰氏阳性菌为主,主要有肺炎链球菌、金黄色葡萄球菌和表皮葡萄球菌等,根据上述结果选择的抗生素治疗效果良好。
Objective To investigate the distribution and drug resistance of pathogenic bacteria in the cerebrospinal fluid of senile patients with purulent meningitis(PM)and its guiding effect on clinical drug use.Methods 305 elderly PM patients admitted to our hospital from May 2020 to May 2023 were selected for bacterial culture and drug resistance analysis of cerebrospinal fluid samples,and the distribution and drug resistance of pathogenic bacteria in the patient's cerebrospinal fluid were statistically analyzed.According to the results of drug sensitivity,the use of clinical antibiotics was guided and the therapeutic effect was analyzed.Results A total of 115 strains of pathogenic bacteria were detected in the cerebrospinal fluid of 305 elderly PM patients,the detection rate was 37.70%,of which 72 strains were gram-positive,accounting for 62.61%,mainly streptococcus pneumoniae,staphylococcus aureus and staphylococcus epidermidis.42 strains of gram-negative bacteria,accounting for 36.52%,were mainly escherichia coli,klebsiella pneumoniae and pseudomonas aeruginosa,1 strains of fungus,accounting for 0.87%.The results of drug sensitivity test showed that all strains of gram-positive bacteria in the cerebrospinal fluid of elderly PM patients had resistance rates of over 80% to ampicillin and penicillin,over 60% to oxacillin,less than 20% to linezolid,and less than 10% to amikacin.No strains resistant to vancomycin and teicolanin were detected.The resistance rate of all gram-negative strains to ampicillin,cefazolin and levofloxacin was above 80%,the resistance rate of cefepime was above 60%,the resistance rate to imipenem was less than 20%,and the resistance rate to amicacin was less than 10%.According to the results of drug resistance analysis,antibiotics with low drug resistance rate were selected for treatment.The protein concentration and white blood cell count in the patient's cerebrospinal fluid were lower than before treatment,while the sugar concentration was higher than before treatment(P<0.05),and the total effective rate was 81.97%(250/305).Conclusion The pathogenic bacteria in the cerebrospinal fluid of elderly PM patients are mainly gram positive bacteria,including streptococcus pneumoniae,staphylococcus aureus,staphylococcus epidermidis,etc.The antibiotics selected according to the above results have good therapeutic effect.
作者
林蕾
邱华章
陈宗元
许鲁宁
LIN Lei;QIU Hua-zhang;CHEN Zong-yuan;XU Lu-ning(Department of Pharmacy,Sanming First Hospital Affiliated to Fujian Medical University,Sanming 365000,Fujian Province,China)
出处
《罕少疾病杂志》
2024年第12期12-14,共3页
Journal of Rare and Uncommon Diseases
关键词
化脓性脑膜炎
脑脊液
病原菌
耐药性
用药指导
Purulent Meningitis
Cerebrospinal Fluid
Pathogenic Bacteria
Drug Resistance
Medication Guidance
